Weight Loss can be Dangerous

THE CASE

The Australian Therapeutic Goods Administration has placed a range of weight loss products called "Hydroxycut" on it's watch list.

It's all a bit bizarre.

The TGA is responding to the US FDA's (Food and Drug Administration) asking the supplier, Iovate Health Sciences Inc, to recall the product and advising consumers to stop using it. This follows a spate of reports of adverse reactions and even a death associated with Hydroxycut.

The Australian supplier of the Hydroxycut range has explained that the product sold here is different from the US product, and therefore is safe. A recall is not warranted. Unfortunately for them this statement flies in the face of the Australian advertising that states:

"Hydroxycut^® is America's #1 selling weight-loss supplement and is a brand name sold in over 70 countries around the world. It has been a lasting weight-loss brand. And it works!"

In other words they are saying:

1. "Buy our product - it works in the US"
2. "Don't worry about the US safety warnings, our product is different"

....Duh!!....

Most of the ingredient appear top be ordinary things found in most kitchens, such as tea, coffee and ginger (sure is an expensive way to buy these). We know what it contains, but there is not the slightest indication of HOW it works.

When will our regulators really start to regulate? All therapeutic products both mainstream and complementary must be forced to pass the following tests:

IS IT SAFE? and DOES IT WORK?

In addition products that receive any public subsidy such as by the Pharmaceutical Benefits Scheme (PBS) or by out heavily subsidised health funds need to pass another test -

IS IT AS EFFECTIVE AS EXISTING PRODUCTS?

Anyway, back to Hydroxucut. The online version of Choice, the media arm of the Australian Consumers Assocoation (ACA) has issued a warning:

"CHOICE does not believe the Therapeutic Goods Administration (TGA)’s advice to stop using Hydoxycut dietary supplements purchased online from the US provides adequate consumer protection. "

MY VERDICT

Hear Hear!

And make sure the product you are using has one of the Australian Listing numbers on the packaging. If it doesn't it is probably illegally imported with even less assurance of integrity and quality.

HOMEOPATHY for dummies

THE CASE

Homeopathy has a long history. It was invented in the late 1700s by German physician Samuel Hahnemann. He based it on treating "like with like", his theory being that a condition can be cured by a substance that produces the same signs and symptoms in a healthy person. But this is where it becomes scientifically problematic, because a necessary corollary of this is that the weaker the medicine, the more effective it becomes.

With the blossoming of physics and chemistry in the late nineteenth century it became obvious that the basic tenets of homeopathy did not stand up to scientific scrutiny. Put simply, if you keep diluting a solution there will become a time when there is no active ingredient left, and most homeopathic products can be shown mathematically to exceed this limit.

Remember the less that isn't there, then the more beneficial the homeopathic remedy!

Another problem is that homeopathy has never been shown to be any more effective than a placebo. The Lancet dated 27/08/2005 published the results of a study that concluded that there was no evidence for the effectiveness of homeopathy, and went on to say:

"doctors need to be bold and honest with their patients about homeopathy's lack of benefits"

Or as the National Advisory Council for Complementary and Alternative Medicine (NACCAM) website says:

"Overall, clinical trial results are contradictory, and systematic reviews and meta-analyses have not found homeopathy to be a definitively proven treatment for any medical condition."

It is hard to think of any other group of products that so successfully avoids the scrutiny of consumer protection legislation. Not only is there no hard scientific evidence that it works, but homeopathy actually claims to contravene the basic laws of physics and chemistry. Most homeopathy practitioners no longer pretend that the extreme dilutions they use contain any active ingredients. They instead rely on magic, claiming that the water somehow remembers the chemicals that have been diluted away, and the preparation institutes a healing process as if they were still there. The real question is, how come the water remembers the beneficial effects of the substance but forgets the side effects and the toxic effects. Water must have selective memory loss. I will reiterate, there are no laws of physics, chemistry or biology that support this highly imaginative theory.

I recently wrote:

Homeopathy is to pharmaceutics as astrology is to astronomy, in each case the former is fantasy and the latter is scientific. Time and time again homeopathy has been proven (yes proven!) to be exactly as effective as a placebo.

Usually homeopathy is just a piece of harmless junk pseudo-science. The only loss is financial, but ocasionally it gets dangerous. For example up to 2002, homeopathic "vaccines" for meningococcus, hepatitis B and influenza were being sold, these were banned by the Therapeutic Goods Administration (TGA) on 9/09/2002. This ban remains in place. The danger is that naive, well meaning parents were allowing their children to be given these non-therapeutic "vaccines" in the mistaken belief that they would be protected from diseases.

Until someone proves that dilution beyond Avogadro's number is meaningful, or can even present a cogent argument on how it could possibly be meaningful, I believe that any pharmacist who practises homeopathy is guilty of fraud, if not professional malpractice. They have the scientific training to know better. If they really must practice homeopathy, it should be away from a pharmacy so that this daft money and time waster is not given a false credibility that it does not deserve.


MY VERDICT

Please don't accuse me of having a closed mind. There have never been any reasons, of physics, chemistry, biology, logic, mathematics, or medicine, given for how homeopathy could possibly work(see below)*. Any perceived benefits are either fraudulent, imaginary or the placebo effect.

DO IT YOURSELF HOMEOPATHY

According to homeopathic principals "like treats like", so if a severe blow to the head with a hammer causes a headache, then it should be possible to treat your migraine with some very light hammer blows. Try it at home sometime, but don't blame me if it doesn't work.

*there is no support for homeopathy in physiology, pharmacology, anatomy, biochemistry, common sense, herbalism, pharmaceutics or statistics either.

FURTHER READING

The Cognitive Dissonance of Homoeopathy
http://sciencebasedpharmacy.wordpress.com/?s=homoeopathy

“Did you hear about the patient that was taking homeopathy?"
"He forgot to take a dose and died of an overdose.”
(thanks for the nice joke Scott)

COSMECEUTICALS where white lies earn big money

THE CASE

About homeopathy I wrote:

"It is hard to think of any other group of products that so successfully avoids the scrutiny of consumer protection legislation."

Well, I was wrong, there is a whole industry that was specifically designed to circumvent as many consumer protection laws as possible.

About ten years ago the word "cosmeceutical" was popularised. The intention was to give cosmetics the scientific respectability of pharmaceuticals by using a semantic trick. Cosmeceuticals are cosmetics that the manufacturers claim have drug-like benefits. Examples include products that claim to reverse skin anti-aging, prevent or cure wrinkles, or reverse hair-loss. Such products are labelled with claims that superficially seem specific and credible, but on close examination are often quite meaningless.

For example, a hair product may say "makes your hair 3 times stronger". To a normal person this means that on average, before treatment, a strand of hair will support a given weight, and after treatment the same hair would support 3 times this weight.

To a cosmetic company this claim means something very, very different. A number of volunteers are paid to try the product, then asked their opinion. In this case 3 times as many users of the product thought their hair was stronger as opposed to weaker. They then claim "makes your hair 3 times stronger" By using semantics instead of science the advertisers are presenting a subjective opinion as an objective fact.

This method is also used to "quantify" essentially unquantifiable positive or negative attributes like sheen, smoothness, frizziness, vibrancy, radiance or plumpness.

Remember as Benjamin Disraeli (not Mark Twain) said:

"There are three kinds of lies: lies, damned lies, and statistics."

Decide for yourself which category this behaviour belongs to.

In most jurisdictions cosmetics and cosmeceuticals are tested for safety, but there is no corresponding testing of efficacy. In other words there are no requirements to prove that the preparations actually live up to the manufacturer's claims.

This brings me directly to the concept of "Angel Dusting". Cosmeceutical manufacturers are very fond of putting sub-therapeutic amounts of active substances in preparations then carefully wording the associated literature, making sure that it tells the truth. They say this preparation contains "ingredient X". They also say that "ingredient X" is good for treating "condition Y". But what they carefully don't claim is that their product will treat "condition Y", because it can't. There is simply not enough "ingredient X" in it. This neatly skips around all sorts of regulative hurdles in many jurisdictions. Hey! does this remind you of homeopathy?

Attendees at the 2008 annual meeting of the the Australasian College of Dermatologists were told that the multi-national skincare companies are discouraged from testing their products in scientific trials, because if they products actually worked they might be reclassified from cosmetics to prescription drugs. So basically these companies are trying to have two bob each way. As the CEO of the college Dr John Flynn says, products that are truly effective are usually prescription only.

The meeting was also told that sunscreens are the only ingredients that actually work to prevent aging. Consumers are therefore allowing themselves to be ripped off by paying hundreds of dollars for useless products. The best way to treat your skin, is a non-soap cleanser followed by an application of sunscreen each morning - and that's it.

The February 2008 edition of Cosmos magazine put it quite neatly:

So it's not just consumers being left in the dark. Not even scientists know what these products actually do. The cosmeceutical industry operates outside of accepted scientific methodology. The in-house studies of cosmetic companies have to be taken with a grain of salt, and the scientific literature that does exist doesn't seem to address the fundamental questions: do the active ingredients penetrate human skin? Do they do it in the mixtures found in creams? What concentrations do they reach? What effects do they have when they get there?

But help may be on the way, our drug regulator the TGA has put these purveyors of half truths on notice. It has issued a warning that specious claims such as "scientifically tested "and "clinically proven" should not be used unless there is real evidence based research to back them up. Thank goodness and about time!

MY VERDICT

If the claims for a product seem too good to be true, they almost certainly are. Cosmeceuticals are often homeopathic style products manufactured by multinational companies.

Go to your local pharmacy. Walk quickly past all the Clarins, L'Oreal, Estee Lauder and Clinique products (notice how they always have French names no matter where they are based). Buy a big tub of sorbolene cream, preferably without glycerine, as glycerine is a false moisturiser. Then buy bottle of non-soap cleanser manufactured by a reputable company, if in doubt always choose the one with the least number of ingredients. This way you will be able to look after your skin properly for six months for less than $20. Now spend the savings on good quality sunscreens.

BRITISH MEDICINE is rapidly heading for a new Dark Age

THE CASE

The heir to the throne His Royal Highness the Prince of Wales (appropriately and correctly written in Latin as "Princeps Wallie") is clearly not a man of the Enlightenment otherwise he would know there is no such thing as alternative medicine, there is only proven medicine or unproven medicine. Once a particular therapy satisfies the "evidence based medicine" (EBM ) criteria it becomes proven and hence mainstream.

Similarly if new evidence shows that a therapy is no longer appropriate, then it should be dropped- like chloroform and ether for anaesthesia or the poisonous arsenic containing Salvarsan for syphilis or cupping or blood-letting.

In an article published in The Times 30/12/2000 the Prince himself wrote:

The traditional herbal remedy of St John's Wort, for example, has been found to work as well as tricyclic antidepressants in treating mild to moderate depression, with fewer side effects. Admittedly, there are reservations about its interaction with particular drugs - but sufficient science-based support is there to warrant its prescription in trained hands.

Fair enough, this is all true. So although St John's Wort is a traditional herbal medicine it also satisfies the EBM criteria, therefore it is not alternate - it is proven.

Contrast this with another of the misguided Prince's advocated therapies, reflexology. Reflexologists claim it has benefited almost anything including (but not limited to) improved sleep, boosted lymphatic system, detoxified system, improved circulation, promoted body awareness, increased vitality, balanced nervous system, cured head neck and back aches, abolished muscle and joint pain, removed digestive problems including diarrheoa and constipation, cured colds and flu, stopped travel sickness, abated period pain, cured infertility. There is not a shred of evidence that it does anything except give you a jolly good foot massage. In other words this is an unproven therapy.

The problem is that these therapies are taking an ever increasing proportion of the British health budget. The National Health Service (NHS) is funding a proliferation of alternative health services. British universities are teaching more alternative health courses leading to degrees. It is hard to see how learning a totally unscientific discipline (actually anti-scientific is a more accurate adjective) like homeopathy can justify the awarding of a BSc. Homeopathy is to pharmaceutics as astrology is to astronomy, in each case the former is fantasy and the latter is scientific. Time and time again homeopathy has been proven (yes proven!) to be exactly as effective as a placebo.

Some of the finest medical academics in Britain have complained about the Prince's involvement in pushing alternative medicine. They have highlighted inaccuracies in a British taxpayer funded book endorsed by the Prince titled "Complementary Health Care: A Guide for Patients". The book makes extravagant, unproven and even dangerous claims, such as that chiropractic and homeopathy can be used to treat asthma.

While we are at it let's not legitimise unproven therapies by labelling them "alternative". The word "alternative" suggests peers amongst equals, these therapies are not a true alternative. For example ear candling is not a real alternative to proper medical treatment for an ear infection. Similarly to label them "complementary" is also an attempt to legitimise them. The main thing they complement is the bank balance of the practitioner. Don't allow proponents to get away with these weasel words, they are simply unproven.

"Either it is true that a medicine works or it isn't. It cannot be false in the ordinary sense but true in some 'alternative' sense."

(Prof. Richard Dawkins, Oxford, April 2001)

It getting worse, now the meddling Prince's Foundation for Integrated Health is proposing a "Kitemark" scheme for medical services that agree to sign a pledge to provide complementary therapies.

Silver and gold levels of membership, with more stringent levels of criteria, would then follow, and eventually a fully fledged kite-marking scheme to accredit the quality of provision.

According to the Foundation's literature to earn this stigma a practice has to:

1. Agree to provide integrated care
2. Provide at least one complementary therapy in-house
3. Have at least one partner in the practice with a specialist interest in integrating conventional and complementary medicine
4. Ensure all partners are happy to discuss complementary therapies with patients
5. In order to retain their membership after three years, members will have to conduct significant event audits, clinical care audits and seek patient views on the integrated services offered by their practice

A little knowledge really is a dangerous thing.

MY VERDICT

University money is a scarce resource and is better used for teaching true science such as physics, chemistry and biology, than populist pseudo-intellectual alternative medicine.

The precious health budget should be use for actual proven therapies, not for unproven, and unscientific mumbo-jumbo.

Complementary and alternate health care practitioners and products need to be carefully monitored, self-monitoring is not sufficient.

Please let's not fall into this trap in Australia.

Sex Test for your Baby

THE CASE

Now you can go to your favourite pharmacy and for about $95.00 buy a test kit that will accurately determine the gender of your baby as early as eight weeks - or so the manufacturers claim.

Dr. Ted Weaver the President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists can't see how it could be accurate at eight weeks. He points out that there is no supporting evidence for the claim of 90% accuracy, nor is there any information on how it works. However anecdotal evidence indicates that the accuracy it is about 80%,

The Australian Christian lobby says it should be banned, because it will increase the demand for abortions if the sex of the baby is not what the parents want. Although abortion on the grounds of gender selection is illegal, the managing Director of the Australian Christian Lobby, Jim Wallace said "That we would allow a product that would allow eugenics to be practiced and started in the home is just unbelievable".

NSW Health Minister John Della Bosca says go to your doctor instead.

The President of the Australian Council of Natural Family Planning, Evelyn Brien, was also worried that by enabling parents to determine the sex of their babies early in pregnancy "they could decide to abort the pregnancy if it's not the sex of their choice." "Morally, that's unacceptable."

All of these people miss the point.

If you are the sort of person who sneaks around and secretly opens up Christmas presents before Christmas, then this test may appeal to you. Ask yourself why you need to know the sex of your unborn baby? Surprises are nice, do you really want to spoil the fun just so you can paint the bedroom the right colour?

The only good reason to test the sex of an unborn baby is if there is the possibility of a familial sex-linked genetic disorder such as Haemophilia or Fragile X Syndrome. Any other reason is just a type of voyerism. Even the adverts say it "bridges the curosity gap"'.

In a very muddy business here are some facts:

The adverts say go to your local pharmacy for one of these kits, but it is available in very few pharmacies.

The adverts claim 90% accuracy but offer no proof of this, beyond a few testimonials.

The adverts say it is accurate from as little as six weeks after the first missed period.

The mechanism of the test is a secret.

MY VERDICT

I wonder if it is any more accurate than the old method of putting some Drano in a urine sample. I am told that Drano turns dark in a boy pregnancy but does not change in a girl pregnancy. I have also been told that it turns blue for boys and pink for girls (no really!).

http://www.babygenderprediction.com/drano-gender-prediction.html

IATROGENIC DISEASE

The Case

The following conversation is imaginary but strongly based on a real visit to the doctor by an acquaintance of mine.

Hello Doctor...

Good morning, how can I help you today?


...I've got a terrible pain...

I suggest you take two paracetamol four times a day. That usually helps control pain.


...in my back...

Luckily, back pain often responds to manipulation, I can give you a referral to either a physiotherapist or a chiropractor whichever you prefer. If neither of these help you could try acupuncture.

...and my legs...

In that case I think I should prescribe a non-steroidal anti-inflammatory as well. And here is an antacid in case it upsets your stomach.

...sometimes it's so bad I can't even get up...

You can't get up! That’s no good; well I better give you a script for Viagra! Take one tablet and you will be up within 20 minutes. If it doesn't work we can always increase the strength.

...in the mornings, and I keep waking up all night...

You better take a course of sleeping tablets; I recommend temazepam or better still zolpidem -Take one tablet 20 minute before bedtime with a glass of warm milk.

...with shooting down my legs...

Goodness me! You’ve been in a shooting? I'll send you for a body scan to make sure there are no pellets lodged anywhere.While we are at it I better test you for lead poisoning, but don't worry the mortality from lead poisoning is quite low in adults. If the test comes back positive I'll give you chelation therapy to help remove it.

...and agonising pain...

If the pain is that bad you better take an opiod as well as the paracetamol, Here's a script. Trouble is these might make you constipated, so I'll write in some laxitives for the constipation, and also an antidiarrhoeals in case the laxitive gives you diarrhoea.

...It all started when I sneezed...

Well, sneezing is easily controlled; I'll add an antihistamine and some nose drops to your script so it won't happen again. And while you are at it I'll give you your influenza shot, and here is a script for an antiviral in case we get that swine flu epidemic.

...and I suddenly got a terrible spasm in my back...

The drug of choice for spasms is still diazepam, take one tablet up to four times a day, mind you it will make you very drowsy, so you may need to take a big dose of caffeine to counteract this. Wait a minute I'll give you a script for dexamphetamine, that should keep you alert.

...and it really hurts when I cough...

Pholcodeine is a good cough suppressant.

...and laugh...

I usually prescribe chlorpromazine or sertraline to control inappropriate emotion.

....actually, I think I better go and get a second opinion....

(goto start)

My Verdict

It speaks for itself.

How COUGH and COLD remedies work - a heretical view

THE CASE

Following up on the recently famous youtube video, I have just read an article in the New Yorker Magazine about Nicholas White, the man trapped in a lift (an elevator) for 41 hours. Bad enough, but deep in the article is an even more appalling fact:

The "Door Close" button in most lifts doesn't work.


Apparently the button's only function is to make the occupant think that they have some sort of control. Can this really be true? We get into a lift and press the required floor button then jab at the "Door Close" button a few times..... hey presto the door closes, thus reinforcing our belief that the button works. But the truth is the action and the effect are completely unlinked, it is a timer that closes the door not the button.

Similarly most pharmacists and doctors do not really believe that cold remedies work. Their only function is to make you think that you can do something. The cold will last from ten days to three weeks with or without treatment. But patients persists in buying their favourite nostrums, because just like "you press the button and the door closes", you take the remedy and the cold goes away. Again the action and effect are completely unlinked, it is the passage of time that cures the cold not the remedy.

MY VERDICT

The treatment that works is the one you were using when you got better. There is no evidence based research indicating that over the counter cough and cold treatments have any effect on shortening the duration of illness.

NOTE

To be absolutely correct the button apparently does work when the lift is in service mode, accessed by a key.

FURTHER READING

Coldfx: More Hype that Hope for Colds and the Flu
http://sciencebasedpharmacy.wordpress.com/2009/02/27/cold-fx/